Electronic tool can help predict impact of chemotherapy in frail patients
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Key takeaways:
- Electronic frailty index helped predict risk for poor outcomes after chemotherapy in frail patients with breast, colorectal or lung cancer.
- The index was particularly helpful in frail patients with breast and colorectal cancer.
CHICAGO — An electronic frailty index may help to predict risk for poor outcomes, including mortality, in patients undergoing chemotherapy.
“Chemotherapy treatment in older people often poses a difficult dilemma for clinicians,” Agnieszka Michael, PhD, MRCP, associate professor in oncology, consultant medical oncologist and medical director of Surrey Clinical Trials Unit at University of Surrey, said during a presentation at ASCO Annual Meeting.
“The fitness assessment for older patients is not ideal,” she added. “We have therefore asked the question whether an electronic frailty index [eFI], which is generated from preexisting medical records, can improve outcomes for frail patients.”
The eFI was developed from a cumulative deficit frailty model and calculates a measure of frailty — no frailty, mild frailty, moderate frailty or severe frailty — with preexisting conditions such as fractures, falls, memory, mobility issues, sight, hearing, anemia and more.
Michael and colleagues conducted a retrospective data analysis of patients with cancer who were treated with chemotherapy from 2015 through 2018 using data from the Public Health England Systemic Anti-Cancer Therapy Dataset to determine if eFI predicted adverse outcomes of chemotherapy in patients with frailty.
Patients included in the study had stage II to stage III breast cancer, stage III colon cancer or stage IIIB to stage IV non-small cell lung cancer.
The researchers calculated eFIs for 78,799 patients, of whom 17,951 had colorectal cancer, 22,052 had lung cancer and 38,796 had breast cancer.
In this patient population, 20,388 were aged 70 years or older, and 58,411 were younger than 70 years.
Michael and colleagues found that 19% of patients had mild frailty, 7.7% had moderate frailty and 3.6% had severe frailty on the eFI; 4.2% died within 30 days of being included in the Systemic Chemotherapy Dataset.
The researchers found that, among patients with colorectal cancer, the risk for dying within 30 days of inclusion in SACT was twice as high in patients aged 70 years or older compared with younger patients (OR = 2.04; 95% CI, 1.58-2.64). The risk for death was similar in both age groups in patients with colorectal cancer with mild eFI (OR = 1.07; 95% CI, 0.78-1.45), and higher in patients aged 70 years or older with moderate frailty (OR = 1.6; 95% CI, 1.1-2.33) and severe frailty (OR = 2.13; 95% CI, 1.34-3.39).
In patients with breast cancer, the risk for 30-day mortality was significantly elevated among patients aged 70 years or older compared with younger patients (OR = 6.38; 95% CI, 4.29-9.49). When analyzed by eFI, researchers found that the risk for 30-day mortality was also higher in patients aged 70 years and older who were classified with mild frailty (OR = 1.45; 95% CI 0.78-2.71), moderate frailty (OR = 3.5; 95% CI, 1.82-6.75) and severe frailty (OR = 5.73; 95% CI, 2.66-12.3) compared with younger patients.
Among patients with lung cancer, Michael and colleagues determined that while 30-day mortality did not differ between the age groups (OR = 0.95; 95% CI, 0.88-1.03), the risk increased among those aged 70 and older who had mild frailty (OR = 1.17; 95% CI, 1.07-1.28), moderate frailty (OR = 1.28; 95% CI, 1.15-1.44) and severe frailty (OR = 1.48; 95% CI, 1.28-1.77).
“In conclusion, electronic frailty index closely predicts poor outcomes from chemotherapy in patients with early colon cancer, breast cancer and first-line treatment of lung cancer,” Michael said during the presentation.
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Michael A, et al. Abstract 12009. Presented at: ASCO Annual Meeting 2023; June 2-6, 2023: Chicago.
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